Pathologie 3

Question 1

The student is able to name the signs and symptoms corresponding to a cervical radiculopathy.

Answer 1

• Neck pain
• Radicular pain: shooting pain
• Tingling, burning sensation
• Loss of strength: arm / hand
• Pain arm / hand
• Atypical symptoms as, weakened deltoid/rotator cuff, , headaches

Question 2

The student can name the directions of scapular diskynesia.

Answer 2

→ Winging: protrusion margo medialis
→ Shrugging: protrusion margo superior
→ Tipping: protrusion angulus inferior

Question 3

The student is able to name the consequences of spondylosis in the long term (spondylolysis, spondylolisthesis, spondylodesis)

Answer 3

→ Spondylosis: umbrella term for degenerative defects of the spine. Often occurs at the disc or facet joints. The symptoms are diverse and develop gradually.

• Spondylolysis: vertebral fracture → interruption of the connection between the vertebral body and the vertebral arch (arcus).
• Spondylolisthesis: displacement of one vertebra relative to the other vertebra. Usually L4, L5 and S1 are affected, the lower in the back the more pressure
• Spondylodesis: fixation of the vertebra

Long-term consequences of spondylosis: when there is degeneration in the spinal column, all kinds of complaints and disorders can arise. Including specific back conditions.

The most common symptoms of spondylosis are:
• Instability spinal column
• Syndesmophytes (extra bone formation around the edges of the vertebra)
• Sclerosis of the cover and closing plates (due to increased pressure load on the bone of the vertebral body)
• Spinal column stiffness

Question 4

The student is able to name the characteristics of lumbar radicular syndrome.

Answer 4

A problem in the lumbosacral region. Radicular means that it has something to do with the radix (nerve root).

Symptoms:
→ The radiating pain in the buttock/leg is more intense than pain in the back

→ There is neuropathic pain:
• Numbness
• Stabbing pain
• Paresthesias (tingling)
• Decreased reflexes
• Hypoaesthesia (decreased sensitivity)

Question 5

The student is able to name the aetiology of osteoporosis.

Answer 5

Etiology (cause)

Between the twentieth and thirtieth years of life, the bones reach their maximum mass (peak bone mass). High-quality food (not too much fat and sugar) with sufficient vitamin D, magnesium and calcium, exercise/sports and preferably at least fifteen minutes a day exposure to sunlight are important for good bone formation.

Between the ages of 40 and 60, bone mass begins to decline. This is due to increased bone breakdown by osteoclasts and decreased bone formation by osteoblasts. Age-related changes in the bones are the main cause of osteoporosis.

• Too little exercise
• Calcium deficiency
• Vitamin D deficiency
• Postmenopausal women, less estrogen production
• Smoking and excessive alcohol use (speeds up the process of bone decalcification)
• Use of drugs: prednisone, corticosteroids
• Malnutrition/poor eating habit

Question 6

The student is able to name the pathogenesis of osteoporosis.

Answer 6

Pathogenesis (origin, development and course):

• Primary osteoporosis: loss of bone mass density due to aging process. There is no specific cause
• Secondary osteoporosis: the cause is identifiable. E.g. by using certain drugs or conditions that increase the risk of osteoporosis: underweight, osteoporosis in families

Question 7

The student is able to name the symptoms of osteoporosis.

Answer 7

Symptoms

• (Low) back pain without an identifiable cause
• Local knock, pressure and shaft pressure pain from the spinal column
• Noticeable length reduction
• Enhanced thoracic kyphosis

Question 8

The student is able to has knowledge of primary deforming osteoarthritis of the hip.

Answer 8

→ Primary arthrosis (without detectable provoking factor); is based on cartilage degeneration. The surface becomes frayed and pieces can break off.

→Secondary arthrosis deformans; is caused by:
• Anatomical abnormalities that put extra stress on the joint (such as a shorter leg)
• Joint inflammation
• Prior trauma (injuries)
• Endocrine* abnormalities
• Neurological disorders
• Metabolic Disorders

Question 9

The student is able to name the differences between primary gonarthrosis and secondary gonarthrosis.

Answer 9

→ Primary gonarthrosis
The cause of gonarthrosis is unknown

→ Secondary gonarthrosis
The cause is a previous condition:
• Meniscus injury
• Cruciate Ligament Problems
• Damage to cartilage
• Lower extremity misalignment
• Overweight

Question 10

The student is able to name the different possibilities for the surgical treatment of gonarthrosis.

Answer 10

→ Cartilage repair operations
Because hyaline cartilage has poor blood circulation, it can hardly repair itself.
however, there are cartilage repair surgeries:
• Artificial hyaline-like cartilage (still in development)
• Transplantation of hyaline cartilage
• Tap into fibrocartilage

→ Prostheses
• Unicompartmental knee endoprostheses, a prosthesis on one side/condyle
• Total knee replacement. In most pts, the ACL and sometimes the PCL must be removed,
flexion should be possible up to 100 degrees. The greatest danger is the infections that can affect the prosthesis

→ Arthrodesis
Securing the joint, this is almost never done because it does the mobility of the knee no good. The leg can no longer flex.

→ Osteotomy Posture Correction
The knee can be divided into 3 compartments: lateral compartment (lateral femoral condyle and the lateral part of the tibial plateau), medial compartment (medial femoral condyle and the medial part of the tibial plateau) and the patellofemoral compartment. The goal of osteotomy is to transfer the load to the correct compartment, thereby reducing the symptoms.

Question 11

The student is able to name the different causes that could impede tendon recovery (risk factors).

Answer 11

• Under/overload
• Hormonal influence, eg through stress
• Medication: for example, antibiotics can cause collagenolysis (breakdown of collagen)